Will the Welsh Government follow the lead of the UK Government and assess whether the travel times and distance for NHS treatment negatively affects patient outcomes?
The BMJ research did not definitively conclude that outcomes were worse for people who had to travel further for NHS treatment. It stated that the results of the studies were mixed and concluded that a relationship between travelling further and having worse health outcomes cannot be ruled out.
There is a large body of evidence which suggests that providing specialist services on fewer sites can improve outcomes for patients, as demonstrated by advances in a number of specialties. These include stroke, vascular, thoracic and neonatal services, as well as the development of major trauma centres across the UK. This view has been validated by reviews by Royal Colleges and also the independent Parliamentary Review into Health and Social Care, published recently.
Health boards are responsible for providing their local populations with services which are evidence based and result in the best possible outcomes. Services must be sustainable, accessible, cost-effective and delivered as close to people’s homes as possible. The public expects timely access to the services they require, wherever they are delivered, including access to GPs and wider primary care services as well as to secondary care or mental health.
The NHS Wales Planning Framework 2018/21 sets out the principles which health boards should follow when developing their Integrated Medium Term Plans (IMTPs). A key delivery priority is timely access to care, as this is a key indicator of quality.
Set within the context of longer-term clinical services strategies, IMTPs require health boards to set out commissioning intentions and delivery milestones for clinically led transformation over the next three years. This includes planning and delivering the majority of care closer to home through primary care cluster collaboration for a sustainable, accessible and integrated multi-professional, multi sector primary care service.
In any modern healthcare system it will be necessary for patients to travel for more specialist services. How specialist they are will affect how far people travel, whether that is for consultant-led services which are usually delivered in a hospital/clinic with the initial referral being made by the General Practitioner; or a tertiary service – highly specialised treatment and care, within a hospital environment.
When changes to services are considered, health boards will need to take account of the geography and demographics of their areas when deciding on the most appropriate location of services. This includes the full implications for its population, taking account of whether the travel times and distance for NHS treatment would negatively impact on patient outcomes.